America’s AIDS Miracle

In 2003, across all of sub-Saharan Africa, just 50,000 people were on ARVs; now more than 9 million are. There is no reason, in the next few years, that we cannot virtually end mother-to-child transmission of HIV in even the most challenging environments. Unheralded, we just passed a tipping point: in 2013, more people were added to the rolls of those on lifesaving treatment for HIV/AIDS than the number who were newly infected. That crossover of trend lines should mark the beginning of the end of AIDS.

Say those last seven words out loud and wonder at them. How did we get to a position that, had it been suggested not long ago, would have been thought impossible?

… credit the Administration of George W. Bush. The 43rd President had come into office interested in Africa’s untapped potential, and in the summer of 2001 he pledged $200 million to the new Global Fund to Fight AIDS, Tuberculosis and Malaria. A year later, he committed $500 million to fight mother-to-child transmission of HIV. The next day, he called Josh Bolten, then his deputy chief of staff, into the Oval Office and told him, “Think even bigger.”

for whatever reason, Bush thought big, and his team–Bolten; Gerson; Tony Fauci, the veteran AIDS researcher at the National Institutes of Health; and others–delivered. In his State of the Union message in January 2003, Bush announced a truly astonishing $15 billion commitment to tackle AIDS in Africa, in what became PEPFAR, the President’s Emergency Plan for Aids Relief, which remains the largest program devoted to combatting a single disease that any nation has ever launched.

The speech and the pledge were the drama. but it is perhaps what has happened since–the quotidian business of sticking with what works–that has been most inspiring about the U.S. effort on AIDS. On World AIDS Day in 2011, President Barack Obama paid tribute to Bush and PEPFAR and said he was “proud that we have the opportunity to carry that work forward.” That the President did–working again with a bipartisan coalition on the Hill–and then some. At a time of fiscal austerity that extended to every element of the federal budget, the amount the U.S. committed to PEPFAR and the Global Fund grew from $5.8 billion in fiscal year 2008 to $6.3 billion in 2013.

PEPFAR has evolved to follow where the science leads us. We now know, for example, that antiretroviral treatment and voluntary male circumcision can serve as prevention tools, reducing the risk of passing HIV on to others. So the program has scaled up its efforts in those areas while also targeting its resources to the regions of greatest need. But what Obama said in 2011 remains true: “The fight against this disease has united us across parties and across Presidents.”